Psychological First Aid: Helping Children Better Manage Stress

Psychological First Aid: Helping Children Better Manage Stress

No school, no church, no playdates with friends, no summer vacation trips…life has been and continues to be extremely stressful for everyone—including children.

Adults can often identify what is stressful in their life and talk about it. Children, on the other hand, have not mastered these skills making it difficult for them to articulate what is creating stress or ask for what they need to manage stress.

While we cannot eliminate all our children’s stress and anxiety, there are things we can do to help. Just like First Aid is a group of behaviors helpers utilize when someone has been in an accident, Psychological First Aid is a group of behaviors helpers utilize when someone has a stressful or traumatic experience.

Signs of Stress in a Child

Instead of talking about what is going on for them, children frequently exhibit signs of stress in one of the following ways:

Irritability.

When stressed, children often are either chronically irritable throughout their day or react with high levels of irritability when things do not go the way they had expected them to go.

Tantrums.

When children’s emotions outstrip their skills, they often melt-down. While an occasional tantrum for young children is normal, stress can increase both the frequency and the intensity of tantrums.

Frequent headaches or stomachaches.

Just like adults get tension headaches or a knot in their stomach when anxious, children have these same physical reactions to stress. If your child frequently complains of headaches or stomach aches, it is important to check with your physician to be sure of what is happening in addition to helping your child find healthy ways to cope with the stress in their lives.

Change in sleep patterns.

When our bodies are stressed, going to sleep and staying asleep can become difficult. Children struggling to get to sleep, waking in the night, or complaining of bad dreams may be experiencing the physiological effects of stress. If stress leads to depression, you may find your child sleeping more than normal.

Difficulty sitting still or concentrating.

Healthy children are normally active. However, they should also be able to sit still and concentrate for about five minutes as preschoolers and between 15-20 minutes in elementary school. If your child struggles to sit still without fidgeting or having screen, this may be a sign they are stressed.

Talking about being afraid or worried.

Children will often either talk about their fears or act their fears out in their play. Parents can tend to miss this sign because the things they talk about being afraid of are often not things which feel realistic or upsetting to adults. It’s easy to miss the worry level a child may have when questioning if the family dog will get COVID because it doesn’t have a mask.

Psychological First Aid Tools

Parents and other caregivers can utilize some of the Psychological First Aid tools to promote children’s resilience to the stress they are experiencing.

Connect and Listen.

Children are often a steady stream of chatter making it easy to overlook their comments while you are folding laundry, fixing supper, or attempting to work from home. Connecting with your child requires focusing exclusively on them and what they are saying/doing. Listening requires tuning in to both the words your child is saying and the underlying meaning hidden in those words.

When your child implores you to put a mask on the family dog, acknowledge you heard them and, instead of telling them all the reasons it is unnecessary, explore the underlying emotion. You might do this with a statement like, “It’s really important for you that Fido have a mask. Can you tell me more about why it is important?”

Connected listening also requires not judging what your child is saying as good or bad, right or wrong, reasonable or unreasonable. Don’t assume you know what your child is thinking or feeling. Instead, ask open ended questions that invite them to share more about what they are thinking/feeling.

Assess Level of Distress.

As you read the list of symptoms describing how children react to stress, you may have realized your child is exhibiting some of these behaviors.

The next step is to look at the level of impairment or disruption these symptoms are causing. The child who is easily comforted after occasionally waking in the night with a bad dream shows some mild symptoms of stress. A child who wakes crying inconsolably multiple times a night and refuses to go back to sleep is exhibiting more severe symptoms and may require a different level of assistance.

It is important to be aware of the ways your child’s stress is impairing their ability to function in age appropriate, healthy ways.

Choose What You Address.

The old adage, “The squeaky wheel gets the grease” applies to children—especially if you have multiple children. Reacting to every situation consistently doesn’t ensure you address what is most important.

If you have more than one child, take time to step back, look at changes in each of your children, and choose how you want to address the changes in each child. Some children get quieter when they need more assistance while others get louder and more demanding.

By taking a moment to prioritize how you want to attend to each of your children and their needs, you won’t overlook the child who is withdrawing while attending to the one who is having more frequent tantrums.

Also, don’t try to fix everything at once! If your child is experiencing more than one symptom of stress, pick one to work on instead of attempting to address them all.

Provide Practical Assistance.

The assistance you provide needs to fit the developmental level of your child as well as the severity of the symptoms. Your three-year-old’s fear that the family dog will get COVID, may need a brief conversation about the differences between what makes dogs and humans sick. However, your normally calm and laid back eight-year-old who can’t get to sleep every night, wakes with nightmares, tantrums multiple times daily, and refuses to talk with you about what they are thinking/feeling, may need the assistance of a therapist.

Consider some of these practical steps regardless of your child’s age:
  • Provide Information

    Providing children with age-appropriate information helps them to make sense of what is happening. Young children who understand wearing a mask makes sure they don’t get sick or make someone else sick will be more compliant about wearing a mask and less worried about needing to do so.

  • Normalize Feelings

    Help your child understand what they’re feeling is normal and they’re not alone in what they are feeling. “Lots of children feel…” or “I have felt…too” can be helpful statements.

  • Set Expectations

    When children know what to expect it calms fear and helps them focus. Telling them they may sometimes feel upset, fearful, or angry and this is okay both normalizes their emotions and sets an expectation. Give them information about what will/won’t be happening and then help them make a plan to deal with this reality.

  • Build Skills

    You can teach your child simple techniques to reduce the stress their body feels. Practicing these skills with your child will reduce your stress as you help them reduce theirs.

Simple Stress Reducing Skills

By utilizing these Psychological First Aid tools, you can attend to your child’s stress around the events within our world and teach them skills to enhance their resiliency both now and throughout their lives.

Deep Breathing

  1. Lay on your back and lay your hand gently on your stomach.
  2. Slowly breath in over a count of five making your stomach puff out as it fills with air (watch your hand to see this happen).
  3. Hold breath for two counts.
  4. Slowly exhale over a count of five and watch your stomach flatten and your hand go down as you do this.
  5. Repeat five times.

Spaghetti and Noodles

  1. Make your arms and your legs as stiff as a piece of uncooked spaghetti.
  2. Hold them in this stiff position for a count of three.
  3. Now make them as relaxed and limp as cooked noodles.
  4. Repeat five times.

Worry Box

  1. Get a stack of index cards and a box with a lid
  2. Decorate your worry box however you would like
  3. Empty all the worry thoughts from your head by writing them down on the index cards
  4. Put all your worries in your worry box by putting the cards in the box
  5. Close the lid on the worry box and put it away somewhere you can’t readily see it.
  6. When a worry thought tries to sneak into your head, remind yourself, “Nope, that thought is in my worry box so I’m not going to think about it until I get the box out.”
  7. Once a day (space this out over time) take your worry box out and talk about the worries with an adult. When you have talked about them, put them back in the box and put them away until tomorrow.

Jean Holthaus, LMSW, LISW has been providing outpatient therapy services since 1995 when she earned her Masters of Social Work degree from the University of Iowa. She has worked for Pine Rest since 1997. She currently serves as manager of the Telehealth Clinic and the Hastings Clinic and is also a Pine Rest Outpatient Regional Director.

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